Forms & Reports
For Use by State Agencies
Forgery Forms

Please contact and request the forgery paperwork packet to begin the claim process. Please indicate "forgery claim" in the subject line of the email..

Rural Fire District Assistance / Mutual Finance Organizations
Forms - required
  • Mutual Finance Assistance Application
  • Per Neb. Rev. Stat. 35-1204 The agreement shall: a) Have a duration of at least three years; b) Require that all members of the mutual finance organization levy the same agreed-upon property tax rate within their boundaries for one out of every three tax years covered by the agreement; and c) Require that all members of the mutual finance organization levy no more than such agreed-upon property tax rate for the remaining tax years covered by the agreement.
  • Per Neb. Rev. Stat. 35-1204 State Treasurer's MFO Calculation Spreadsheet
  • Per Neb. Rev. Stat. 35-1207 Distribution of Prior Year Funding
Neb. Rev. Stat. § 77-2215
Lost Warrant Affidavit - PDF
  1. Contact agency that issued the warrant.
  2. If agency is not known, contact the Treasury Management Division of the Treasurer’s Office who will help you locate the agency.
  3. Fill out Lost Warrant Affidavit and be sure your signature is notarized.
  4. Present affidavit to agency that issued the warrant. Note: Some agencies may have their own affidavits for you to complete.

A claim for an expired warrant must be filed with Administrative Services Risk Management. The State of Nebraska Uncashed Warrant Claim Form can be downloaded from the Risk Management website.

Uncashed Warrant Claim Form (Risk Management website):

Guide on How to File a Claim for an Uncashed Warrant (Risk Management website):

Risk Management Claims page:

A warrant is expired when it has not been cashed within one year of the date of the warrant. A claim must be filed in order for the warrant to be reissued. The form must include your original signature and required documentation. Mail the original, signed claim form to the following address:

Risk Management Division
State Claims Board
P.O. Box 94974
Lincoln, Nebraska 68509-4974

For information, contact Risk Management at 402-471-2551.

Internal Revenue Service Refund Inquiries
800-829-1954 (toll free)
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